Exposure anxiety (EA) is a condition identified by Donna Williams in which the child or adult feels acutely self-conscious; it leads to a persistent and overwhelming fear of interaction.

Source: Exposure anxiety in autism | Network Autism

EA can be quite crippling as it it causes the person to feel acutely self-conscious and leads to a persistent and overwhelming fear of interaction. And that makes any attention from other people feel potentially threatening so that the child feels ‘exposed’ each time someone looks at him, talks to him or even compliments him.

Source: Autism and Exposure Anxiety. Don’t look at me! – Autism Daily Newscast

Exposure Anxiety: a definition

Exposure Anxiety is the internal parent watching its vulnerable and exposed baby being stolen by the world outside or given away by ‘the self’; being robbed of control by what are felt as ‘outside forces’. Exposure Anxiety is a self-parenting survival mechanism, an intense often tic-like involuntary self-protection mechanism that jumps in to defend against sensed ‘invasion’. When it becomes chronic, it is self-perpetuating – like a boulder hurtling down a hill, gaining momentum. Chronic, uncontrolled, acute Exposure Anxiety is about addiction to your own adrenaline. We all experience stress and some of us are more driven, more passionate, more fixated and intense, more independent, more controlling, more dominant or passive, more jumpy or aloof, naturally. In most cases where Exposure Anxiety goes hand in hand with the metabolic, digestive and immune system disorders that co-occur in the largest percentage of people on the autistic spectrum. The chronic stress of Exposure Anxiety exacerbates physiological problems which then affect information processing as well as throw neurotransmitter balance into a state of chaos, forming a self-perpetuating loop. The person with Exposure Anxiety who lives and works with those who do not understand the condition are bound to find the self-in-relation-to-other, directly-confrontational approach of the environment seems to make Exposure Anxiety worse.

Exposure Anxiety has two faces and is the heaven and the hell, the lure of sanctuary and the suffocation of the prison.

Exposure Anxiety is a mechanism that craves the extreme and retaliates against any sense of impending invasion. It is like taking a feeling of severe shyness and multiplying it by fifty, yet its presentation is extremely confusing to onlookers. People with severe Exposure Anxiety can be frozen, or they can be manic and high. They can be prone to despair and depression, driven and creative, or unable to connect. They can be obsessive or fiercely indifferent, compulsively helpful or aloof. They can be passive or controlling; bombastic or phobic; deeply empathic or compulsively violent; open and honest or secretive and intensely private. Exposure Anxiety is likely one of a range of conditions relating to what has been coined ‘Reward Deficiency Syndrome’, essentially relating to reward feedback and impulse control mechanisms in the brain.

Exposure Anxiety makes it difficult to dare ‘expressive volume’ in a directly-confrontational (self-in-relation-to-other) world

Exposure Anxiety is about feeling your own existence too close up, too in your own face.

If I could draw you a picture of acute chronic Exposure Anxiety, I’d draw you a rainbow unseen within heavy stone walls. There’d be places in the stone where the cement had crumbled, been chipped away and some of the colour had come streaming out like a ray of light into the world. I’d draw you a picture of someone inside a prison, an invisible prison with replica selves on the outside, each a contortion, a distortion of the one you can’t see who can’t get out. I’d draw you a picture of someone avoidant with a social person waiting inside for the keys and a way out. I’d show you the compulsive, with a face manic in the midst of a diversion to distract you, to control you, from getting in. I’d draw you a face with a plastic smile, perfect movements, a learned handshake and a gut full of despair and loneliness in a world that applauds the ‘appear’ at the expense of ‘self’; suicide without a corpse.

Source: Williams, Donna (2002-09-14T23:58:59). Exposure Anxiety – The Invisible Cage . Jessica Kingsley Publishers. Kindle Edition. 

…when the autistic children were able to access their strongly held interests, the school staff didn’t need to prompt them anywhere near as much(or even at all), and the children were more motivated, independent and relaxed. Not only did this enable the supporting adult to take on a more constructive role, but the lighter-touch support meant that it was easier for peers to engage with the autistic children too.

…the autistic children in my study were turning to their strong interests in times of stress or anxiety. And there has certainly been a lot of research which shows that autistic children and young people find school very stressful. So it might be the case that when this autistic trait is manifested negatively in school, it is a direct result of the stresses that school creates in the first instance.

In my study, I found that when the autistic children were able to access their intense interests, this brought, on the whole, a range of inclusionary advantages. Research has also shown longer-term benefits too, such as developing expertise, positive career choices and opportunities for personal growth. This underscores how important it is that the education of autistic children is not driven by a sense of their deficits, but by an understanding of their interests and strengths. And that rather than dismissing their interests as ‘obsessive’, we ought to value their perseverance and concentration, qualities we usually admire.

Source: Autistic children and intense interests: the key to their educational inclusion? – woodbugblog

As his mom, I know there would have been telltale signs throughout the day. But they’re small clues that can be easily missed, as he would have been largely compliant, so therefore no one would have realized there was any problem. But I know as the day progressed, his complexion would have become paler as the energy sapped out of him with each passing hour.

He may have struggled to eat his lunch due to high anxiety. A nervous giggle would have squeaked out when his teachers tried to speak to him. He would have put his head down on the table during lessons or possibly rocked back and forward on his chair to calm himself down. And as the pressure mounted and the clock ticked toward home time, there may have even been some finger picking and sleeve chewing.

My son shows these signs of stress through his body language and gestures. He can’t always communicate his needs verbally, so they can get missed.

The can be a common challenge facing many children on the autism spectrum. Some children are able to contain their feelings all day at school, with the teacher blissfully unaware there’s a problem. However, the stress hormones are slowly building and building inside. This creates a situation that can put incredible pressure on families— especially if teachers don’t understand or believe what the parents are telling them. So let’s think about it this way for a minute…

Source: ‘Delayed Effect’: Child With Autism Melts Down at Home, Not at School | The Mighty

I updated “Interaction Badges: Opportunity but Not Pressure” with a selection from “History of ANI” as featured in “Loud Hands: Autistic People, Speaking”.

“Opportunity but not pressure” is a core principle for all Autreat activities: attendance at presentations, informal discussions that are held in the evenings, swimming and other recreational activities, socializing, meals (people who prefer to make their own meal arrangements are able to register for Autreat without paying for Autreat meals), on-site lodging (people who prefer to stay at an off-site hotel can register for Autreat at a commuter rate)—all participation is purely voluntary.

Freedom from pressures and expectations 

For some autistic people attending Autreat, the sudden absence of pressures and expectations to behave in certain ways can be quite disorienting at first. NT people are often disoriented as well, and may experience culture shock. One NT attendee described feeling unsure of how to behave and how to relate to people, confused about how to interpret other people’s behavior, and anxious that he might offend people without realizing it (personal communication). In other words, he was able to experience at Autreat some of the same social confusion and discomfort that autistic people frequently experience in NT society. While this can be somewhat disturbing, a number of NT people have reported that it was a valuable experience that helped them to better understand what autistic people go through on a daily basis.

The absence of any expectation or pressure to socialize, and the knowledge that they’re free to withdraw at any time, seem to free many autistic people to want to socialize.”

Source: History of ANI

Featured in: Loud Hands: Autistic People, Speaking

Respect for each person’s solitude and personal space was essential, and the interaction badges allowed everyone to know at a glance who was open to talking. All of the conference events were optional, including the orientation itself; the overriding principle was “opportunity but not pressure.”

Source: Silberman, Steve. NeuroTribes: The Legacy of Autism and the Future of Neurodiversity (p. 448, 449). Penguin Publishing Group. Kindle Edition.

Via: Interaction Badges: Opportunity but Not Pressure

Rather, the entirety of the mental health field and the paradigm under which it operates is a modern-day religion rife with all the familiar problems and benefits that exist in any religion. Most importantly, however, there is hope if people are willing to move beyond what society tells us we “must” do. People have been healing from great pain for 200,000 years—the mental health professions have existed for less than 200. While there are some things we have learned, we need to stop trying to re-invent the wheel. People need love, support, community, to be heard, to be valued, to be validated, to have purpose, to have health and housing, to have nutrition both physically and emotionally—it is not rocket science and doesn’t become such just because we keep saying that it is.

People who enter services are frequently society’s most vulnerable-people who have experienced extensive trauma, adversity, abuse, and oppression throughout their lives. At the same time, I struggle with the word “trauma” because it signifies some huge, overt event that needs to pass some arbitrary line of “bad enough” to count. I prefer the terms “stress” and “adversity.” In the book, I speak to the problem of language and how this insinuates differences that are not there, judgments, and assumptions that are untrue. Our brains and bodies don’t know the difference between “trauma” and “adversity”-a stressed fight/flight state is the same regardless of what words you use to describe the external environment. I’m tired of people saying “nothing bad ever happened to me” because they did not experience “trauma.” People suffer, and when they do, it’s for a reason.

If patients willingly adopt the role of defectiveness, then how is the doctor doing anything harmful or wrong? People who grew up as the scapegoat, who believe they are dirty or defective or bad, who are ashamed of their existence or believe they should be someone they are not, who have led their entire lives being marginalized and discriminated against in society-these are the people who most frequently enter mental health services. They are also those most readily vulnerable to accepting these messages under the guise of treatment and care. It is not until people are willing to start to consider that, in fact, they are not defective in the least, rather, that they are just flawed and unique human beings adapting to incredible pain that they can start to actually believe in themselves enough to heal.

Of course, there is simply the existential issue of mental health professionals that may be unbearable for them to face: If I am not fixing a distinct and identifiable problem, what, then, is my purpose? If the real healing power I have is something that any human being could ostensibly provide, if willing, why did I spend all those years in school and possibly hundreds of thousands of dollars? If these are not specific diseases related to specific biochemical or genetic flaws, why have I specialized-and who doesn’t like feeling special? And, worse, if I am not addressing people with genetic illnesses and biochemical problems, what, really, am I doing when all I have to offer are drugs and technological interventions?

This problem is not unique to mental health professionals. Medical doctors are caught in a similar dilemma when it comes to obesity, heart disease, diabetes, chronic inflammation, and many autoimmune diseases, even cancer. What do these doctors do when they realize that these problems are almost entirely due to an industrialized diet largely based on corporate interests-the sugar industry, soy bean manufacturers, Monsanto-and that if people just ate the way humans are designed to eat, these problems mostly would not exist? And, of course, these issues are entirely intertwined with mental health problems! If these are not specific diseases related to specific biochemical or genetic flaws, why have I specialized? If these problems are not really genetic illnesses and biochemically-based problems, what, really, am I doing when all I have to offer are drugs and technological interventions?

A black man spends his life being marginalized and aggressed, dismissed because of his fear and pain-should he enter the system, he is no longer “less-than” because of his blackness, now he’s marginalized and dismissed as “schizophrenic.” A sexually-abused young woman who was told she “wanted it,” was blamed, and was never given the opportunity to be angry enters the system-she now is “borderline” and once again blamed for being too sexualized, for causing staff to behave in shameful ways, and condemned for her anger, even when it is taken out on herself.

Perhaps more than any other, the most common enactment is that associated with the individual who grew up with a narcissistic parent in constant need of adulation, intolerant of discomfort or self-reflection, and who was a master in the art of gaslighting.

We live in a society that values stoicism, complete control over one’s behaviors, lack of emotional expression, “politeness” at the expense of authenticity-I love New York!-and an eerie Stepford Wife-like ideal of conformity. Mental health professionals often are selected for their ability to represent these values. Those troublemakers who tell the truth, are spontaneous(otherwise called “impulsive”), who laugh or find humor in the darkness(or “inappropriate affect”), who refuse to conform(or my favorite, “oppositional”) are ostracized and pathologized for the threat they pose to propriety. They generally don’t make it through the training process. I know I almost didn’t. It is the Anglo-Saxon way. It also is what makes most of us completely miserable.

Source: Psychiatric Retraumatization: A Conversation About Trauma and Madness in Mental Health Services – Mad In America

I updated “Anxiety, Ambiguity, and Autistic Perception ” with a selection from “On the Double-Mindedness Developed Among the Different – An Intense World”.

In The Souls of Black Folk, W.E.B. Du Bois says that blacks have a sort of doubleness in them not found among whites. Blacks cannot just “be themselves,” but must always think about how they are being perceived by whites. This creates a sense that you are always of two minds: that you are not only thinking and doing, but that you are thinking about how others perceive you, and adjust accordingly. Whites never have to deal with this. Being the majority and having the majority power, they can just be themselves without worry about how anybody is thinking about them.

Du Bois would probably not be surprised if he learned that other minorities were put in similar situations in the U.S., but it probably didn’t occur to him that there were people out there with different kinds of minds, and that they too would develop such a doubleness.

I know all about this double-mindedness, because I experience it constantly. I not only have to think about what I’m going to say or do, but I have to think about how others might take it. I can either just say or do whatever I want as I want and hope that I don’t do something that will set people off, or I can always consciously think about everything I say or do before I say or do it, testing against what I expect the expectations are (and hoping I’m getting those right). If it takes me a moment to respond to something, it’s because I’m going through all this nonsense to make sure I don’t say or do something wrong.

Source: On the Double-Mindedness Developed Among the Different – An Intense World